Monitoring for arrhythmia in transthyretin cardiac amyloidosis with noninvasive ambulatory patch devices

Background Transthyretin cardiac amyloidosis (ATTR-CA) is associated with an increased incidence of arrhythmias. We hypothesized that 2-week noninvasive ambulatory cardiac rhythm monitoring of patients with ATTR-CA would detect high rates of atrial fibrillation/atrial flutter (AF/AFL) and nonsustained ventricular tachycardia (NSVT). Objective The study sought to characterize arrhythmia in patients with ATTR-CA on 2-week, noninvasive cardiac rhythm monitors. Methods A total of 38 patients with ATTR-CA who underwent 2-week remote external patch monitoring were included in this single-center retrospective study. An age-matched control group included 38 patients who underwent the same cardiac rhythm monitoring as part of neurological workup. Results Of the ATTR-CA cohort, 26.3% had AF/AFL and 81.6% had NSVT. ATTR-CA was associated with higher rates of AF/AFL and NSVT compared with the control group. At a median follow-up of 45 weeks, there was no association between the presence of AF/AFL or NSVT on remote monitor in the ATTR-CA group and a composite of adverse clinical outcome. Conclusion ATTR-CA was associated with an elevated rate of AF/AFL and an even higher rate of NSVT on noninvasive ambulatory monitors. While evidence regarding the management of arrhythmias, particularly NSVT/ventricular tachycardia, in ATTR-CA remains limited, 2-week noninvasive cardiac monitoring can be considered to aid in risk stratification for both atrial and ventricular arrhythmias. (c) 2024 Heart Rhythm Society.Published by Elsevier Inc. This is an open access article under the CCBY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).